HomeMy Public PortalAbout10938 WILDFLOWER RD_Sewer__ A ��D APPLICATIONFOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING OaJ1 lL�� 104"C .
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT of BUILDING
rADDRE�S
OCALITY Temple amity
NEAREST
_
FOR APPLICANT TO FILL IN cRoss ST. � A.-.-AV,,
LEGAL
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_DESCRIPTION LOT NO. .>f - OWNER YJ'7-. B. `''Ve eV
r O�,L u„`i:'°`uc d/..�..io La �.
AI L
BLOCK TRACTf3. ADDRESS rJ "-� -
_ 2 s->� _ c� r2 16 San
Ora.n-n -:�_.� �;e�
NO. OF BLDGS. 2 CITY San*
a 'w.al.:r e.LTEL. N0. At E�,,,,,®r_ 1
_SIZE OF_LOT NOW ON LOT d ��
USE OF
BUILDINGS Residence DISTRICT NO. GROUP MAP
1 BK PG
---y- D T1 CCo. 1
CONTRACTOR L_ 11,E Construction o. _ �...� _
t CONNECTION DATA
ADDRESS. 2l- YV r 'Wistaria t�.'�..`r-A .ci'�"�,e - - ------ —
.? r� C? STATION DEPTH ----•
.i' '
CITY ACc`�.di, TEL. N0.Hi 6.22303 -
-'-- -- MANHOLE REFS E 1 ".,, e,',,.. - UPPER
' STATE
REGISTRATION NO. 1l_ r�-- - _
No. DESCRIPTION OF WORK FEE ---- --- — -_-- - ---
HOUSE SEWER CONNECTING 10 i - I - TYPE OF CONNECTION- LENGTH FROM -M-
_
PUBLIC SEWER _ @ $3.50� � Y. CURB_ � .L:`�� M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
-`] --
_PITS AN_D OR DRAINFIELD _ (,. $3,00
- OVERFLOW SEEPAGE PIT,DRAINFIELD -_ --- -- P. C. NO, y
EXTN.,CESSPOOL,DRYWELL,MANHOLE (a $2.00� CO. fM.P. NO. _- 10B N0.
HOUSE SEWER CONNECTING TO -- --� � -- --�- --T
PRIVATE DiSPOSALSYSTEM itis $1.00 j _ _ TRUNK PERMIT'NO.. ROAD PERMIT NO.
� CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT ----_ - --�
-� ALWORK
RK TOE OUSE SEWER OR ABANDON ROUSE @ $1.00 �---�! PERMIT NO
SEWER OR riSPOSAL SYSTEM (a; $1,0p ; INDUSTRIAL
--_t --_--- --_- _..._ WASTE APPROVAL
CONNECTION CHARGE FEE
OWNER'SPERMIT -- -- —_ -- -- ^-- .--
---�-,--- - 4 �O REIMBURSEMENT FEE
AUTHORIZATION 4.50 APPROVALS
I HAVE AT THIS DATE A. CONTRACT WITH THE HEREIN NAMED CON- ! DATE j INSPECTOR'SSICNATURE
.------------_.-------- -----.__. ___--I _._._: ___
TRACTOR TO CONNECT 'THE. tiBOVE DESCRIBED EXISTING DWELLING j
TO THE PUBLIC SEWER. NEW ROUSE SEWER -
SIGNED THIS—DAY OF.— —19_e
CONNECT CT ADDITIONAL
OWNER OR BUILDING OR INORK _
OWNERS AGENT---N-ew_--__ --- SEPTIC TANK,SEEP PITS)
AND/OP DRAINFIELD
a - READ THIS
LI
-ON LJ
CESSPOOL . D Y4LELL_t�
ANHEREBY
• E
AND Tkis rTH.EABOVE H IS CORRECT AND AGREE TOCOMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGj
PLUMBING AND. SrIe"ERS, ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM �
I HEREBY CERTIFY THAT ! RM PROPERLY REGISTERED AND/OR PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ! I
. CALIFORNIA O1 THAT i AM THE L' A�.,. y1 '
NE OF THE ABOVE — - — ---- --'. ---- ------- -------
DESCRIBED R€SIDE 7.AL P PF Y., ,.^"� � / /✓�� BACKT LL SEPTIC TANKS 0
SCEP. P1 CESSPOOLS
SIGNATURE K' °��✓`. ,,s'j' /,.+�r,/ ,,. i4._',�, j I ---OF PERMI,
IOHN A. LAMBIE, COUNTY ENGINEER VAL DATION ROBERT A.WOOD, CHIEF PL6G. INSPECTOR
CY.n M. 0, CASH / --